The Art of Executive Leadership: Driving Change and Cultivating Compliance Culture with Bill Sanger
Watch Now
Listen Now
Also Available On:
▶ Apple Podcasts
▶ Amazon Music
▶ Spotify
▶ YouTube
-
Too many healthcare organizations treat compliance like internal audit, a function people work around instead of a voice at the table. Bill Sanger spent five decades proving the opposite pays off.
In this episode of the Compliance Leadership Lounge, host Ross Ronan talks with Bill Sanger, former Chairman and Chief Executive Officer of Envision Healthcare, who took four healthcare companies public over his career. The two worked side by side for nearly twenty years, and it shows.
Sanger walks through six habits he looks for in every executive: communicate the vision, lead with empathy, stay adaptive, lead by example, build a collaborative culture, and embrace change only when it improves a process, a patient outcome, or the bottom line. Then he makes a direct case for compliance. In his companies, the compliance officer sat on the executive team and joined board meetings and strategic planning, not as the internal police, but as a partner who could see the business clearly.
His logic is simple. A compliance leader who understands the business can steer it down the right road instead of blocking it. That is how a culture of compliance takes hold, and it starts with the Chief Executive Officer treating the role as the executive position it is. The result is a grounded look at boards, executive growth, and the leadership habits that make compliance part of how a healthy company runs.
-
Where should the compliance officer sit in a healthcare organization?
On the executive team. In Bill Sanger’s companies, the compliance officer joined executive staff, board meetings, and strategic planning, treated as a strategic partner whose skill set is compliance, not as the internal police.
What are the six leadership habits every healthcare executive needs?
Communicate the vision and goals, lead with empathy for patients and staff, stay adaptive to change, lead by example with integrity, build a collaborative and inclusive culture, and embrace change only when it improves a process, a patient outcome, or profitability.
What is a board of directors actually for?
To hire and monitor the Chief Executive Officer and to bring one of three things: a strong network, a complementary skill set, or executive experience the CEO lacks. Sanger’s rule for board members is nose in, hands out. Ask the right questions, but do not manage the company.
How does a Chief Executive Officer build a culture of compliance?
By treating compliance as an executive position and putting the compliance officer on the executive team and the board. When the CEO believes it and lives it, the rest of the organization follows, and compliance stops looking like internal audit.
What is the most important skill for a compliance leader?
Understanding the business. A compliance leader who knows how the business operates can guide it down the right road. One who does not will struggle to do the job.
-
Ross: Welcome to the Compliance Leadership Lounge. I’m Ross Ronan, your guide for insightful discussions in healthcare compliance. Leaders and experts gather here to share their perspectives and wisdom. Whether you’re a CEO, a board member, or a compliance enthusiast, you’re in the right place to learn, grow, and lead with integrity. Today we have Bill Sanger, who served as CEO and chairman of the board for many healthcare organizations. Welcome, Bill. Thanks for joining us.
Bill: My pleasure, Ross.
Ross: Tell me about your experience in healthcare. You’ve done a lot. Hit on a few of those.
Bill: I started my career decades ago, in the 1970s, running hospitals. I found out you can make a good living as a hospital CEO, but you never really create wealth. That’s when I looked at the for-profit side of healthcare. Over the last 50 years I’ve migrated through every aspect of the industry. I’ve taken four companies public and made scores of acquisitions. I officially retired from running companies about six or seven years ago. Now we make investments, usually between one and ten million dollars, mostly in early-stage and startup companies. It’s been an exciting transition.
Ross: I’ve always seen you as more than a healthcare executive who took companies from 150 million to billions. You’re entrepreneurial too. You have an investment arm, you own a winery and an olive oil business. A bit of a jack of all trades.
Bill: Master of none, probably. We have investments in the auto industry, in entertainment, and as you said, the winery and the olive oil business.
Ross: It’s great wine. I have to get back on your wine list. Our history goes back more than 20 years. We worked in a healthcare organization together for about 18 or 19 years. That was my second compliance officer job, and I learned how to be not just a compliance officer but a compliance executive because of what I learned from you and your team. What a ride. I think we handled just about every compliance issue in healthcare.
Bill: I agree. It was an interesting journey, almost see one, do one, teach one. And honestly, I never saw you as a compliance officer. I saw you as a member of the executive team whose skill set was compliance. Others brought finance, others brought operations. You brought compliance. So yes, you held the title, but I saw you as an executive first.
Ross: I appreciate that, and I tell this story to all my mentees. Early in my executive career with you, someone, probably the CFO, upset me. I grabbed my notebook and marched down to your office ready to let you have it. I didn’t care if I quit or got fired. I knocked, walked in, sat down, and before I could start, you said, let’s take a beat. How’s it going? How’s the family? How are the boys? Twenty minutes later I walked out feeling like I’d gotten a raise and a promotion, which I hadn’t. You had this ability to make people feel great whenever they talked to you. That’s the sign of a great mentor and a great executive, and it’s something I still strive for with my own staff and mentees.
Bill: I appreciate you sharing that. It almost brings emotion to me. On leadership, I always tell people: God gave you one mouth and two ears, use them in that ratio. Listen twice as much as you talk. At the executive level you build up a bias, not unlike the diagnostic bias a physician has after seeing the same condition many times. If you take the time to really listen instead of jumping in with the answer, you lead better. Ninety percent of the time I never give the answer. I work with my team to help them get there. The worst organization is one that fails when you leave. You don’t want to make yourself indispensable every day. You want the organization to work with you, not for you. That comes back to listening more than talking.
Ross: I love that. I read something the other day: managers do, leaders be. Giving everyone the answer is doing the work. Showing the example and leading them to the answer is leading. What’s your favorite leadership book? You used to hand these out at strategic planning meetings.
Bill: That’s hard. My favorite is a biography, Team of Rivals, about Abraham Lincoln, by Doris Kearns Goodwin. It shows his extraordinary ability to put himself in other people’s shoes and bring people together. I’m also reading The Next Five Moves by Patrick Bet-David, which compares successful leaders to master chess players who think five or six moves ahead. And a classic I go back to is Competing on Analytics. Every organization has to understand its analytics. Those three belong in the arsenal.
Ross: I asked for one and you gave me three. You read a lot.
Bill: I’ve got some time now. I’m not running companies anymore.
Ross: Healthcare is complex, full of regulations and rules. When you’re a CEO or chairman responsible for the CEOs you put in place, what crucial qualities are you looking for in leadership?
Bill: Let me unpack that. Start with a board and a CEO. Boards are responsible for hiring a CEO and monitoring the direction and performance of the company through that CEO. They answer to shareholders. Too often CEOs see boards as a burden, scrambling to prepare and trying to appease them instead of doing what’s right for the company. So the first question a CEO should ask is, what do I want a board for? A board member should bring one of three things. One, a strong network to open doors. Two, a skill set complementary to your core business, like a luminary physician for an oncology company. Three, executive experience you personally lack, a mentor. If a board member can’t bring one of those, you don’t need them. I was just on the phone with a new CEO whose private equity group wanted him to add a board member. I told him to stop and figure out which of those three things the person brings. We had a great conversation. He needs all three.
Bill: Now from the board’s point of view. The best board members know the rule: nose in, hands out. Know the right questions to ask, but if you start managing the organization, you’ve got the wrong CEO. Mike Smith, one of the best board members I’ve worked with, said that. To ask the right questions, you have to do your work, understand the industry and the company, and spend time with the CEO. You’re of no value unless you understand the business.
Ross: I’d never heard nose in, hands out. From a liability standpoint, a board that does the work becomes part of management and creates risk. The board provides oversight and guidance, not the work.
Bill: Exactly. A board is usually made up of independents and those who financed the company. The agendas are the same, a successful company, but the tolerance levels differ. A debt holder cares about cash flow to pay the debt. Private equity wants its multiple. The independents want the long-term strategy. The chairman’s role is to balance those for the benefit of the company and the CEO.
Ross: Let’s go one step down to executives. When you put executives in place, what are you looking for? A lot of them think an MBA teaches them everything, and we both know that’s not true.
Bill: I lecture to MBA programs, including at Northwestern. There are six things an executive needs to move into top leadership, and you can’t lack any of them. One, strong communication skills, used to convey the vision and the goals so everyone reads from the same hymn. Two, empathy. In healthcare you have patients, staff, and stakeholders, and each has different needs. Smart, freshly minted MBAs need to stop thinking they know everything. You were a nurse before your law degree. Understanding the patient and clinician interaction is part of that empathy. Three, stay adaptive. Reimbursement and technology change fast. If CMS cuts your MRI payment from 2,500 to 800 overnight, you’d better adjust quickly. Four, lead by example with integrity and ethical decision making. People may not know how to arbitrage the yen against the dollar, but everyone knows what’s ethical, and you can’t fool anyone. Five, be collaborative and inclusive. Build a culture that empowers the team. I share my own view last, because I want to hear what I’m missing. When I do, I often change my mind, and I get a better outcome. One plus one equals three. Six, embrace change, but only for one of three reasons: it improves a process, it improves patient outcomes, or it makes the company more profitable. Change for the sake of change, don’t do it. Those six principles are the keys for any executive.
Ross: I love it. Having a framework matters, and several of those hit what’s near and dear to me. Patients come first. Embrace change if it improves patient outcomes. And integrity. Our intro is about leading with integrity. Integrity isn’t about feelings or beliefs, it’s about honesty and a moral compass.
Bill: I love talking to MBA students. They’re sponges. I get notes saying, I tried it, I stopped talking and started listening and felt empathy for the first time. It’s emotional to hear. It’s not rocket science, but it’s a lot of work.
Ross: Let’s take one more step down, to the compliance executive. Healthcare organizations are required to have a compliance officer, who is not a police officer and usually not actually an officer in the governance structure. How do we move these people from being seen as standing in the way to being a strategic partner? From a CEO’s perspective, how do you foster a culture of compliance while driving growth?
Bill: As we said, too often organizations see compliance as the internal police, like internal audit. That starts with the CEO. It’s the CEO’s responsibility to make compliance part of the DNA. When we worked together, people saw you as an executive who contributed to every strategy session and brought a compliance point of view, just like the CFO and operations. So first, the CEO has to recognize compliance as an executive position, and the board has to understand that too. On boards I sit on, I force the issue: the compliance officer needs to be at board meetings. Why? Because otherwise we only hear what the CEO wants us to hear, and the compliance officer needs to understand the whole organization. When you bring compliance to the executive level and the board, people across the organization start to see it as an important role. But that only happens if the CEO believes it and lives it. Otherwise you’re just another internal audit.
Ross: What you did that was groundbreaking for the time, the early 2000s onward, was insist that the compliance officer attend strategic planning meetings. A lot of leaders don’t want compliance there, because that’s where innovation happens. But the right compliance executive can say, I see where you’re going, maybe do it this way instead. You always said, I want compliance at strategic planning, listening, so we don’t waste time going down a road we can’t take. What was the reasoning?
Bill: Compliance is a core part of the company, just like finance and operations. To not have it there would be a void. I always saw our team as a collection of executive talent. You brought compliance, but more than that, you brought an executive thought process. Compliance officers have to be careful not to get pigeonholed. It takes real skill and intelligence to understand the breadth of compliance. A compliance officer is a resource, like the board. If you don’t use them, why have them?
Ross: I also tell everybody who’s in compliance, you have to understand the business. If you don’t know what the business does or how it operates, if you don’t talk to the CEO, the COO, and the directors of operations, you’ll fail nine times out of ten, because you can’t do your job. That’s where executive leadership comes in. I’m echoing everything you’ve said for the last 45 minutes. What a great framework. Bill, I appreciate your time. One last question I ask every guest. We say health is wealth. What do you do to take care of yourself?
Bill: If you want to stay healthy, pick your parents. The genes help. On a serious note, the older you get, the more important health becomes. I’ve always been active, and that changes with the decades. I have two chocolate labs and we run on the beach every day, and I work out three or four times a week, enough to keep the muscles and bones strong. Mental health matters too. People worry too much. I have three children your age, and I tell them not to worry so much, it works itself out. Give yourself downtime. For the first time in a long while, I’m reading novels unrelated to business, just to laugh and let my mind spin out. That combination is working for me.
Ross: I know you’re a surfer too.
Bill: I still surf, though mostly I paddleboard now. A lot of paddleboarding.
Ross: The mental health piece and taking breaks matter. We promote wellness, because if you can’t take care of yourself, you’ll never be a business athlete, as Ed Mylett puts it. That’s how I’ve always seen you, athletic and business wise, the epitome of a business athlete.
Bill: You have to be healthy. Being a CEO is a tough job, no matter the size of the company. You have to have your health.
Ross: The stress will get you. Bill, thank you so much for joining me today. I really appreciate your time. We’ll talk soon. Take care.
-
Bill Sanger is the former Chairman and Chief Executive Officer of Envision Healthcare and a managing partner of Sanger Holdings.
He took four healthcare companies public over a fifty-year career and now backs early-stage healthcare companies as an investor.
He joined Ross Ronan to share his framework for executive leadership and why the compliance officer belongs on the executive team.
“I also tell everybody in compliance, you have to understand the business.”
Related Reading
